Explanation of Benefits Demystified – How to Read Your Delta Dental of Iowa EOB
Have you ever gotten a letter from Delta Dental of Iowa that said in big bold letters on top “Explanation of Benefits – THIS IS NOT A BILL”?
Well, my friend, that piece of paper is what we call an explanation of benefits or EOB. You will receive one after you visit your dentist and it contains a whole lot of information. Below are 18 areas of your EOB to be familiar with.
1. Th: The tooth or area that was treated.
2. Surf: The tooth or surface quadrant that was treated.
3. Service Date: The date the procedure was completed.
4. Proc code: The procedure code that identifies the treatment requested or completed.
5. Procedure description: A description of the procedure requested or completed.
6. Submit amount: The amount billed by your dentist.
7. Free adjust: The difference, if any, between the Submitted Amount and the Approved Amount. This is the amount participating network dentists cannot bill to the Delta Dental plan member.
8. Approved amount: The amount the dentist has agreed to accept as full payment for a service. For participating network dentists, the Approved Amount is the lesser of the Submitted Amount or the applicable maximum plan allowance/negotiated amount.
9. Allowed amount: The amount that Delta Dental uses to calculate payment responsibility under the terms of the patient's dental benefits.
10. Deduct applied: The deductible is the amount the patient must pay before benefits begin. If the procedure is subject to a deductible, this column will indicate the amount that has been subtracted from the Allowed Amount before calculating Delta Dental's payment and the Patient's Payment.
11. Carrier co-pay: The portion of the Allowed Amount Delta Dental will pay, up to the patient's plan maximum.
12. Patient payment: The amount the patient is responsible for paying under the terms of the Delta Dental plan benefits. If the procedure is subject to a deductible, the Patient Payment includes the amount from the Deductible Applied column. Except in certain circumstances involving coordination of benefits with another plan, a Delta Dental participating network dentist may only bill the patient for this amount.
13. Carrier payment: The amount Delta Dental paid.
14. Ref code: Explanatory statements applicable to claims processing, benefit coverage and/or processing policy.
15. Ded satisfied: The amount the patient has paid to date towards the annual deductible.
16. Max used: The amount of the patient's annual maximum coverage limit used to date.
17. Ortho max used: The amount of the lifetime maximum coverage limit for orthodontic benefits used to date.
18. Other carrier paid: The amount paid under the provisions of another group plan when benefits have been coordinated.
At Delta Dental of Iowa, we are passionate about oral health and its importance to generations of families. For more than 40 years, we have worked to improve oral health by emphasizing preventive care and making dental coverage accessible to all Iowans.
Visit the Member Connection at www.DeltaDentalia.com for secure, personalized information on eligibility, claims history and claims status for you and your dependents.